{"id":"https://openalex.org/W4415463539","doi":"https://doi.org/10.1186/s40537-025-01295-3","title":"A review of distinct machine learning classifiers for healthcare fraud detection","display_name":"A review of distinct machine learning classifiers for healthcare fraud detection","publication_year":2025,"publication_date":"2025-10-23","ids":{"openalex":"https://openalex.org/W4415463539","doi":"https://doi.org/10.1186/s40537-025-01295-3"},"language":"en","primary_location":{"id":"doi:10.1186/s40537-025-01295-3","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s40537-025-01295-3","pdf_url":"https://journalofbigdata.springeropen.com/counter/pdf/10.1186/s40537-025-01295-3","source":{"id":"https://openalex.org/S2737955091","display_name":"Journal Of Big Data","issn_l":"2196-1115","issn":["2196-1115"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Big Data","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://journalofbigdata.springeropen.com/counter/pdf/10.1186/s40537-025-01295-3","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":null,"display_name":"Ethan D. Curtis","orcid":null},"institutions":[{"id":"https://openalex.org/I63772739","display_name":"Florida Atlantic University","ror":"https://ror.org/05p8w6387","country_code":"US","type":"education","lineage":["https://openalex.org/I63772739"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Ethan D. Curtis","raw_affiliation_strings":["Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA"],"affiliations":[{"raw_affiliation_string":"Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA","institution_ids":["https://openalex.org/I63772739"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5116057760","display_name":"Preston Billion\u2013Polak","orcid":null},"institutions":[{"id":"https://openalex.org/I63772739","display_name":"Florida Atlantic University","ror":"https://ror.org/05p8w6387","country_code":"US","type":"education","lineage":["https://openalex.org/I63772739"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Preston Billion-Polak","raw_affiliation_strings":["Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA"],"affiliations":[{"raw_affiliation_string":"Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA","institution_ids":["https://openalex.org/I63772739"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5089170562","display_name":"Taghi M. Khoshgoftaar","orcid":null},"institutions":[{"id":"https://openalex.org/I63772739","display_name":"Florida Atlantic University","ror":"https://ror.org/05p8w6387","country_code":"US","type":"education","lineage":["https://openalex.org/I63772739"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Taghi M. Khoshgoftaar","raw_affiliation_strings":["Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA"],"affiliations":[{"raw_affiliation_string":"Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA","institution_ids":["https://openalex.org/I63772739"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5057260089","display_name":"Borko Furht","orcid":"https://orcid.org/0000-0002-3584-9659"},"institutions":[{"id":"https://openalex.org/I63772739","display_name":"Florida Atlantic University","ror":"https://ror.org/05p8w6387","country_code":"US","type":"education","lineage":["https://openalex.org/I63772739"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Borko Furht","raw_affiliation_strings":["Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA"],"affiliations":[{"raw_affiliation_string":"Department of Electrical Engineering and Computer Science, Florida Atlantic University, 777 Glades Rd., Boca Raton, FL, 33431, USA","institution_ids":["https://openalex.org/I63772739"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I63772739"],"apc_list":{"value":1060,"currency":"GBP","value_usd":1300},"apc_paid":{"value":1060,"currency":"GBP","value_usd":1300},"fwci":2.1819,"has_fulltext":true,"cited_by_count":1,"citation_normalized_percentile":{"value":0.90958516,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":96,"max":98},"biblio":{"volume":"12","issue":"1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11652","display_name":"Imbalanced Data Classification Techniques","score":0.9983999729156494,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T11652","display_name":"Imbalanced Data Classification Techniques","score":0.9983999729156494,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T11396","display_name":"Artificial Intelligence in Healthcare","score":0.9693999886512756,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.6155999898910522},{"id":"https://openalex.org/keywords/transfer-of-learning","display_name":"Transfer of learning","score":0.5781999826431274},{"id":"https://openalex.org/keywords/deep-learning","display_name":"Deep learning","score":0.5726000070571899},{"id":"https://openalex.org/keywords/class","display_name":"Class (philosophy)","score":0.5087000131607056},{"id":"https://openalex.org/keywords/supervised-learning","display_name":"Supervised learning","score":0.5009999871253967},{"id":"https://openalex.org/keywords/set","display_name":"Set (abstract data type)","score":0.4814999997615814},{"id":"https://openalex.org/keywords/focus","display_name":"Focus (optics)","score":0.4648999869823456},{"id":"https://openalex.org/keywords/unsupervised-learning","display_name":"Unsupervised learning","score":0.4056999981403351}],"concepts":[{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.7994999885559082},{"id":"https://openalex.org/C119857082","wikidata":"https://www.wikidata.org/wiki/Q2539","display_name":"Machine learning","level":1,"score":0.7875000238418579},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.7699000239372253},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.6155999898910522},{"id":"https://openalex.org/C150899416","wikidata":"https://www.wikidata.org/wiki/Q1820378","display_name":"Transfer of learning","level":2,"score":0.5781999826431274},{"id":"https://openalex.org/C108583219","wikidata":"https://www.wikidata.org/wiki/Q197536","display_name":"Deep learning","level":2,"score":0.5726000070571899},{"id":"https://openalex.org/C2777212361","wikidata":"https://www.wikidata.org/wiki/Q5127848","display_name":"Class (philosophy)","level":2,"score":0.5087000131607056},{"id":"https://openalex.org/C136389625","wikidata":"https://www.wikidata.org/wiki/Q334384","display_name":"Supervised learning","level":3,"score":0.5009999871253967},{"id":"https://openalex.org/C177264268","wikidata":"https://www.wikidata.org/wiki/Q1514741","display_name":"Set (abstract data type)","level":2,"score":0.4814999997615814},{"id":"https://openalex.org/C192209626","wikidata":"https://www.wikidata.org/wiki/Q190909","display_name":"Focus (optics)","level":2,"score":0.4648999869823456},{"id":"https://openalex.org/C8038995","wikidata":"https://www.wikidata.org/wiki/Q1152135","display_name":"Unsupervised learning","level":2,"score":0.4056999981403351},{"id":"https://openalex.org/C2989086416","wikidata":"https://www.wikidata.org/wiki/Q15067276","display_name":"Healthcare industry","level":3,"score":0.3635999858379364},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.3440000116825104},{"id":"https://openalex.org/C110083411","wikidata":"https://www.wikidata.org/wiki/Q1744628","display_name":"Statistical classification","level":2,"score":0.34360000491142273},{"id":"https://openalex.org/C58489278","wikidata":"https://www.wikidata.org/wiki/Q1172284","display_name":"Data set","level":2,"score":0.3393999934196472},{"id":"https://openalex.org/C2522767166","wikidata":"https://www.wikidata.org/wiki/Q2374463","display_name":"Data science","level":1,"score":0.3303000032901764},{"id":"https://openalex.org/C51632099","wikidata":"https://www.wikidata.org/wiki/Q3985153","display_name":"Training set","level":2,"score":0.321399986743927},{"id":"https://openalex.org/C75684735","wikidata":"https://www.wikidata.org/wiki/Q858810","display_name":"Big data","level":2,"score":0.31150001287460327},{"id":"https://openalex.org/C2776145971","wikidata":"https://www.wikidata.org/wiki/Q30673951","display_name":"Labeled data","level":2,"score":0.29679998755455017},{"id":"https://openalex.org/C68597687","wikidata":"https://www.wikidata.org/wiki/Q362601","display_name":"Computational Science and Engineering","level":2,"score":0.29159998893737793},{"id":"https://openalex.org/C148524875","wikidata":"https://www.wikidata.org/wiki/Q6975395","display_name":"F1 score","level":2,"score":0.2766000032424927},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.2721000015735626},{"id":"https://openalex.org/C84525736","wikidata":"https://www.wikidata.org/wiki/Q831366","display_name":"Decision tree","level":2,"score":0.257999986410141}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1186/s40537-025-01295-3","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s40537-025-01295-3","pdf_url":"https://journalofbigdata.springeropen.com/counter/pdf/10.1186/s40537-025-01295-3","source":{"id":"https://openalex.org/S2737955091","display_name":"Journal Of Big Data","issn_l":"2196-1115","issn":["2196-1115"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Big Data","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:b77a57ec012b4a53a943cd52531673a0","is_oa":true,"landing_page_url":"https://doaj.org/article/b77a57ec012b4a53a943cd52531673a0","pdf_url":null,"source":{"id":"https://openalex.org/S112646816","display_name":"SHILAP Revista de lepidopterolog\u00eda","issn_l":"0300-5267","issn":["0300-5267","2340-4078"],"is_oa":true,"is_in_doaj":true,"is_core":false,"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Journal of Big Data, Vol 12, Iss 1, Pp 1-23 (2025)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1186/s40537-025-01295-3","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s40537-025-01295-3","pdf_url":"https://journalofbigdata.springeropen.com/counter/pdf/10.1186/s40537-025-01295-3","source":{"id":"https://openalex.org/S2737955091","display_name":"Journal Of Big Data","issn_l":"2196-1115","issn":["2196-1115"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Big Data","raw_type":"journal-article"},"sustainable_development_goals":[],"awards":[{"id":"https://openalex.org/G8396638180","display_name":null,"funder_award_id":"2021585","funder_id":"https://openalex.org/F4320306076","funder_display_name":"National Science Foundation"}],"funders":[{"id":"https://openalex.org/F4320306076","display_name":"National Science Foundation","ror":"https://ror.org/021nxhr62"},{"id":"https://openalex.org/F4320310801","display_name":"Florida Atlantic University","ror":"https://ror.org/05p8w6387"},{"id":"https://openalex.org/F4320317380","display_name":"Universidad del Atl\u00e1ntico","ror":"https://ror.org/05mm1w714"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4415463539.pdf","grobid_xml":"https://content.openalex.org/works/W4415463539.grobid-xml"},"referenced_works_count":43,"referenced_works":["https://openalex.org/W1589492330","https://openalex.org/W1766594731","https://openalex.org/W1930624869","https://openalex.org/W2064675550","https://openalex.org/W2074980655","https://openalex.org/W2109553965","https://openalex.org/W2123402141","https://openalex.org/W2147826622","https://openalex.org/W2295598076","https://openalex.org/W2395579298","https://openalex.org/W2495589275","https://openalex.org/W2646970574","https://openalex.org/W2782767340","https://openalex.org/W2786577118","https://openalex.org/W2935879253","https://openalex.org/W2971477033","https://openalex.org/W3047216992","https://openalex.org/W3084540277","https://openalex.org/W3091163231","https://openalex.org/W3129693849","https://openalex.org/W3176370082","https://openalex.org/W4205252066","https://openalex.org/W4205826793","https://openalex.org/W4211116959","https://openalex.org/W4226147551","https://openalex.org/W4236137412","https://openalex.org/W4285224136","https://openalex.org/W4297808587","https://openalex.org/W4307561206","https://openalex.org/W4312134334","https://openalex.org/W4319863485","https://openalex.org/W4362665241","https://openalex.org/W4385763879","https://openalex.org/W4387578673","https://openalex.org/W4387941172","https://openalex.org/W4393161202","https://openalex.org/W4394924843","https://openalex.org/W4395085610","https://openalex.org/W4396949360","https://openalex.org/W4400645674","https://openalex.org/W4403125025","https://openalex.org/W4403865072","https://openalex.org/W4405861617"],"related_works":[],"abstract_inverted_index":{"Healthcare":[0],"insurance":[1],"fraud":[2,27,67,171],"is":[3,116],"a":[4,24,31,75,93,106,117],"major":[5],"problem,":[6],"with":[7,105],"an":[8],"estimated":[9],"$300":[10],"billion":[11],"lost":[12],"annually":[13],"in":[14,129,174],"the":[15,65,78],"United":[16],"States.":[17],"Machine":[18],"learning":[19,115,134,137],"has":[20],"been":[21],"explored":[22],"as":[23,132],"tool":[25],"for":[26,29,122,138],"detection":[28,68,172],"over":[30],"decade,":[32],"but":[33],"challenges":[34],"remain,":[35],"including":[36],"class":[37],"imbalance,":[38],"dataset":[39],"diversity,":[40],"and":[41,50,58,87,99,119,135,169],"model":[42,109],"interpretability.":[43],"This":[44],"survey":[45],"reviews":[46],"22":[47],"supervised,":[48],"unsupervised,":[49],"semi-supervised":[51,100],"classification":[52,141],"techniques":[53],"published":[54],"between":[55],"December":[56],"2017":[57],"October":[59],"2024":[60],"which":[61,72,102,151],"are":[62,81],"novel":[63,97],"within":[64],"healthcare":[66,175],"domain.":[69],"Supervised":[70],"techniques,":[71],"make":[73],"up":[74],"majority":[76],"of":[77,96],"identified":[79],"works,":[80],"divided":[82],"into":[83],"deep":[84,114],"learning,":[85,124],"graph-based,":[86],"meta-learning":[88],"methods.":[89],"We":[90,111,157],"also":[91],"find":[92,112,146],"small":[94],"set":[95],"unsupervised":[98],"classifiers,":[101],"we":[103,145],"examine":[104],"focus":[107],"on":[108],"explainability.":[110],"that":[113,159],"popular":[118],"effective":[120],"approach":[121],"supervised":[123],"while":[125],"research":[126],"gaps":[127,162],"remain":[128],"areas":[130],"such":[131],"transfer":[133],"incremental":[136],"all":[139],"three":[140],"approaches.":[142],"Most":[143],"concerningly,":[144],"few":[147],"to":[148,165],"no":[149],"works":[150],"establish":[152],"benchmarks":[153],"across":[154],"diverse":[155],"techniques.":[156],"assert":[158],"addressing":[160],"these":[161],"could":[163],"lead":[164],"more":[166],"effective,":[167],"transparent,":[168],"adaptable":[170],"systems":[173],"insurance.":[176]},"counts_by_year":[{"year":2026,"cited_by_count":1}],"updated_date":"2026-04-23T09:07:50.710637","created_date":"2025-10-23T00:00:00"}